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Overview

Ventriculoperitoneal shunt is commonly known as VP shunt. It is a medical device that relieves pressure on the brain caused by excess cerebro-spinal fluid (CSF) accumulation. VP shunt is designed to primarily treat a medical condition called hydrocephalus, which occurs when excess CSF collects in the ventricles of the brain.

The role of fluid on the brain is to protect it from injury inside the skull. CSF acts as a delivery system for nutrients that the brain needs and takes away waste products. Fluid on the brain is reabsorbed into the blood.

Hydrocephalus occurs when the normal flow of CSF is disrupted or the reabsorbtion of CSF in the blood is reduced. This condition can, thus, create an adverse pressure on the tissues of the brain and harm it. A brain shunt surgery can help rectify this condition by diverting the CSF away from the brain, which restores normal flow and absorption of CSF. VP shunt is surgically placed inside one of the ventricles of the brain.

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Before the Treatment

When is VP shunt removal needed?

VP shunt is a mechanical device, so it will go bad eventually. But its total life differs from patient to patient. Every individual has a different body chemistry, some are more sensitive to foreign objects, while others are more tolerant. So the life of a VP shunt depends on your body chemistry and how receptive your body is to a foreign object. This is the reason why removal period of VP shunt is totally unpredictable. The patients are advised to visit the doctor for follow-ups so that the doctor can check on the device and see when it requires a removal.

How it is Performed

The management of hydrocephalus has always been a challenge for neurologists, neurosurgeons, engineers and medical device developers because the nature of CSF is unique to each patient. However, the development of VP shunt has made the treatment of hydrocephalus a bit easier. It has, in fact, become the most successful and primary therapy for hydrocephalus treatment.

A VP shunt looks like a tube and the shunt pathway contains some valves that act as on/off switches. The valve open when the pressure difference across the valve exceeds the valve opening pressure. These valves are usually set to a fixed pressure.

Some accessory devices may be added to the shunt to modify valve functions. Role of accessory devices is to counter gravitational forces and to minimize over drainage of CSF when a patient is in standing position. Further, a bubble like reservoir can provide an external approach to the brain shunt surgery for making any changes in the measurement of pressure.

Recovery

Brain Shunt Surgery Recovery Time

Just after the VP shunt surgery, the patient is kept under close observation for an hour or so and then is transferred to his or her room. Usually, it takes 4 to 7 days for patients to leave the hospital, depending on their clinical progress.

During the hospital stay of the patient with shunt in head, the hospital staff will monitor the heart rate and blood pressure frequently and the specialist will suggest some preventive antibiotics. The result of this monitoring procedure will help determine recovery time after VP shunt. The specialist will make sure that the shunt in head is working properly and will remove the stitches or staples before the patient is discharged from hospital.

The patient can walk and move after the discharge from the hospital, but it may take 2 to 3 weeks to resume daily activities. Patient may feel tenderness in the neck or belly and probably feel tired. In some cases, the patient may have headache for a few weeks after the surgery, but should not experience much pain. Typically, every individual has different recovery time, depending on the age and medical needs.

Precautions After VP Shunt Surgery

The patient may need to lie flat for 24 hours after the shunt in head is placed. Patients are strictly recommended to follow the instructions of the doctor on how to take care of the shunt at home. Patients may be asked to take medicine after VP shunt surgery to prevent infection.Here are some of the precaution that you must take after the brain shunt surgery:

Rest and get enough sleep, it will help you recover.

Do not touch the valve on your head.

Avoid physically involving games and activities for at least 6 weeks.

Do not swim or take a shower until your stitches or staples are removed.

Take low-fat foods such as plain rice, boiled chicken, toast, and yogurt.

Do not take any new medications unless advised by the doctor.

Make sure to contact the doctor before continuing any blood thinner medicines such as clopidogrel, warfarin or aspirin.

Take pain medicines and antibiotics exactly as directed. Do not stop them just because you feel better.

VP Shunt Procedure Complications

The VP shunt procedure is a safe and most common procedure for the treatment of hydrocephalus. But it also involves some complication and risks. Some patients may be advised a VP shunt revision in case of complication or if the device fails to work. According to some studies, about 50 percent of VP shunting in the pediatric population fails within two years of placement and VP shunt revision is often required.However, VP shunt complication rate in adults is less. The most common VP shunt complications in adults are malfunction and infection.

VP shunt malfunction: Partial or complete blockage of the shunt that affects the function of VP shunt intermittently or fully is called malfunction. In VP shunt malfunction, CSF accumulates and resumes the symptoms of hydrocephalus.

VP shunt malfunction is a complication which can occur in adults and any other age group. The blockage can take place from tissue, blood cells or by bacteria. Both the ventricular catheter and the distal part of the catheter can be blocked by tissue from the ventricles or choroid plexus.

VP shunt infections: Infection in VP shunts is usually caused by a person’s own bacterial flora. The most common infection in VP shunt is because of a bacteria called Staphylococcus epidermidis. It is found on the surface of skin, sweat glands and in hair follicles deep within the skin.

This type of VT shunt infection is most commonly seen in one to three months after the surgery. Abdominal infection after VP shunt is also common. A person with VT shunt may also develop a generalized infection, which can become serious quickly.

Pros:

Patients return to usual routine in some days

No pain

Cons

Shunt may fail after a few years

Shunt replacement or removal has its own side effects

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FAQ

Q: How long can you live with brain shunt?

A: The shunt tubing may degenerate over a period of time Therefore, every patient must undergo a revision surgery after every five or ten years. Most of the patients are able to well beyond that period.

Q: How long does it take to recover from a VP shunt?

A: It takes around three to four days to recover from the VP shunt surgery. However, a patient is usually discharged after a week of the surgery.

Q: What are the symptoms of a blocked VP shunt?

A: A headache, vomiting, stiffness in the neck, fever, pain in the stomach, and sleeplessness are some of the symptoms of a blocked VP shunt.

Q: What are the symptoms of VP shunt overdrainage?

A: Increased intracranial pressure, difficulty walking, decreases in appetite, incontinence, and headache are some of the symptoms of VP shunt overdrainage.

Q: Can hydrocephalus cause death?

A: If left untreated, hydrocephalus can indeed lead to death. Additionally, it can lead to intellectual, physical, neurological, and visual changes in the affected individual.

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